A Proposal to Revise the Histopathologic Grading System of Early Oral Tongue Cancer Incorporating Tumor Budding



Elseragy A, Salo T, Coletta RD, Kowalski LP, Haglund C, Nieminen P, Mäkitie AA, Leivo I, Almangush A.


Am J Surg Pathol. 2019 May;43(5):703-709. doi: 10.1097/PAS.0000000000001241.


The World Health Organization (WHO) grading system has a low prognostic value for early-stage oral tongue squamous cell carcinoma; greater prognostic power has been shown with tumor budding analysis. In this study, we combined tumor budding analysis with histopathologic grading according to WHO 2017. In our proposal, a revised grade I tumor is defined as a “well differentiated cohesive tumor”; revised grade II as a “moderately differentiated and/or slightly dissociated tumor”; and revised grade III as a “poorly differentiated and/or dissociated tumor.” We evaluated the prognostic value of this proposed grading system in a multicenter cohort of 311 cases of early oral tongue squamous cell carcinoma. The proposed grading system showed significant prognostic value in multivariable analysis for disease-specific survival with a hazard ratio of 3.86 and a 95% confidence interval of 1.36-10.9 (P=0.001). For disease-free survival, the proposed grading system showed good predictive power in multivariable analysis (hazard ratio, 2.07; 95% confidence interval, 1.00-4.27; P=0.009). The conventional WHO grading system showed a low prognostic value for disease-specific survival and disease-free survival (P>0.05). In conclusion, the prognostic power of the WHO histopathologic grading improved significantly with incorporation of tumor budding. Our proposed grading system can be easily included in pathology reports.

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Link/DOI: 10.1097/PAS.0000000000001241